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r <br /> � NERMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ?j —3 —/D <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '/� I (� —�16 <br /> SITE AODRESS PARCEL TAl(I.D.M PERMIT M <br /> ` c� q'. S ic�rti• f l�uec I3�� P <br /> LEGAL LOT NO. BLOCK TRACT OR SUDDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PER�11T PHONE <br /> TS R AM,A� F� oUSr , },-a�-t1< e.rna� ZoC 2Z4 32y� <br /> N ��n k �'i r� �ro e�.1ra, l SYos' S c''91 o s� ke.�.1- �M�Q 9b'o� 2'2"�57Y� <br /> CONTR.LICENSE!! ���1' �� q,L �.CU _ <br /> R � <br /> USF OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Olher ���U uG <br /> WORK DESCR�PTION UL3oa };r�5�-(�prc.S.Ii�'t S/ J�/1'!� -�dY Il�� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> Toilcl ' A/C–air handling unils� � <br /> — g������� Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Showcr . Wa�erhea�er <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer _ Clolhes dryer �� • <br /> Waler healer _ Range hood '1 n <br />� Sink(servicePoadmop/etc.) _ Exhaust fan '� �� <br /> Dackllow preventer _ Heal pump � ' �^� <br /> Urinal Unit healer <br /> Drinkin� Founlain _ Boiler <br /> I _ Floor dmin = Reirigeration <br /> Grcase Irap Waodslove <br /> _ Roof drains _ Olher_�,u�rT7VfJ/h SY��e� <br /> Olher <br /> CITY OF EVERF:TT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Il�at 1 have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type o(work will be complied with�vhelhor specified herein or noL The granting of a permit does nol presume <br /> to give authoriry to violate or cancel th�provision o(any olher state or local Iaw regulating construction or ihe pertormance oi <br /> conslruclion.Tha1 I am aulhorized by lhe owner of this property to per(orm t'ne work for which application is made and I comply wilh the <br /> Statc ConlraGors Law 18.27 R�and 29fi.200 WAC. <br /> N' 2• 26� )o <br /> Signature ol OwnedC�aclor/Aulhonzed A9ent Date �/ <br /> � <br />